Key result
Patients with prior cancer admitted for acute heart failure had worse median survival (1.6 vs 2.6 years) and were less likely to be cared for in a cardiology ward (difference -2.4%; 95% CI -3.3 to -1.6).
Why the study?
Little evidence exists on survival and quality of care in cancer patients presenting with acute HF.
Does a prior cancer diagnosis affect the presentation, management, and outcomes of patients admitted with acute heart failure?
Cohort (n=221,953)
Yes
Does a prior cancer diagnosis affect the presentation, management, and outcomes of patients admitted with acute heart failure?
Mean Difference: -2.4 (95% CI -3.3–-1.6)
Patients with prior cancer admitted for acute heart failure receive less guideline-directed care and have poorer survival compared to non-cancer patients, largely driven by non-cancer deaths.
Prior cancer flags acute HF patients for potential undertreatment; leaves open whether targeted pathways improve outcomes.
AIMS: Currently, little evidence exists on survival and quality of care in cancer patients presenting with acute heart failure (HF). The aim of the study is to investigate the presentation and outcomes of hospital admission with acute HF in a national cohort of patients with prior cancer. METHODS AND RESULTS: This retrospective, population-based cohort study identified 221 953 patients admitted to a hospital in England for HF during 2012-2018 (12 867 with a breast, prostate, colorectal, or lung cancer diagnosis in the previous 10 years). We examined the impact of cancer on (i) HF presentation and in-hospital mortality, (ii) place of care, (iii) HF medication prescribing, and (iv) post-discharge survival, using propensity score weighting and model-based adjustment. Heart failure presentation was similar between cancer and non-cancer patients. A lower percentage of patients with prior cancer were cared for in a cardiology ward [-2.4% age point difference (ppd) (95% CI -3.3, -1.6)] or were prescribed angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists (ACEi/ARB) for heart failure with reduced ejection fraction [-2.1 ppd (-3.3, -0.9)] than non-cancer patients. Survival after HF discharge was poor with median survival of 1.6 years in prior cancer and 2.6 years in non-cancer patients. Mortality in prior cancer patients was driven primarily by non-cancer causes (68% of post-discharge deaths). CONCLUSION: Survival in prior cancer patients presenting with acute HF was poor, with a significant proportion due to non-cancer causes of death. Despite this, cardiologists were less likely to manage cancer patients with HF. Cancer patients who develop HF were less likely to be prescribed guideline-based HF medications compared with non-cancer patients. This was particularly driven by patients with a poorer cancer prognosis.
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Coles et al. (2023) conducted a cohort in Acute heart failure (n=221,953). Prior cancer diagnosis vs. No prior cancer diagnosis was evaluated on Cared for in a cardiology ward (difference -2.4 ppd, 95% CI -3.3, -1.6). Patients with prior cancer admitted for acute heart failure had worse median survival (1.6 vs 2.6 years) and were less likely to be cared for in a cardiology ward (difference -2.4%; 95% CI -3.3 to -1.6).
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